NCLEX Next Generation NCLEX (NGN) Clinical Judgment and Case Studies

Question 1

In the NCSBN Clinical Judgment Measurement Model, which of the following lists the cognitive layers in the correct order?

Accepted Answer

Recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, evaluate outcomes

Answer

The six layers are recognize cues, analyze cues, prioritize hypotheses, generate solutions, take actions, and evaluate outcomes. They reflect the order in which a nurse notices, interprets, plans, acts, and reassesses.

Question 2

A client 2 days after abdominal surgery has a temperature of 38.9 C, heart rate 118/min, respiratory rate 24/min, a wound with purulent drainage, and new confusion. Which findings are the most relevant cues indicating possible sepsis? (Select the best answer.)

Accepted Answer

Temperature, heart rate, respiratory rate, and new confusion

Answer

Fever, tachycardia, tachypnea, and altered mental status are the systemic findings that meet SIRS and sepsis criteria. Together with the infected-looking wound, they indicate a possible sepsis hypothesis. Demographic details and preferences are not significant clinical cues.

Question 3

A bow-tie style NGN item asks the nurse to choose two actions to take for a client with suspected heart failure exacerbation (dyspnea, crackles, weight gain of 3 kg in 2 days). Which two are the most appropriate?

Accepted Answer

Place the client in high Fowler's position and anticipate a prescribed IV loop diuretic

Answer

Pulmonary congestion and rapid weight gain indicate fluid overload. Sitting the client upright reduces the work of breathing, and an IV loop diuretic removes excess fluid. Lying flat and increasing fluid or sodium intake would worsen the condition.

Question 4

In an NGN trend-style item, a client's urine output decreases from 60 mL/hour to 20 mL/hour over 4 hours while blood pressure drops from 124/78 to 94/58 mm Hg. Which hypothesis should the nurse prioritize?

Accepted Answer

Inadequate renal perfusion from declining circulating volume

Answer

Falling urine output with decreasing blood pressure indicates reduced perfusion to the kidneys, suggesting hypovolemia or early shock. Recognizing this trend is critical for timely intervention.

Question 5

After administering a prescribed IV opioid for post-operative pain of 9/10, which finding should the nurse use to evaluate that the intervention was effective?

Accepted Answer

Client reports pain of 3/10, is resting comfortably, and has a respiratory rate of 14/min

Answer

Evaluating outcomes means comparing client response with expected results. A drop in pain score with stable, adequate respirations shows effectiveness without respiratory depression. A respiratory rate of 8/min is a sign of overdose.

NCLEX Practice Test

NCLEX Practice Test

NCLEX Next Generation NCLEX (NGN) Clinical Judgment and Case Studies